title: Mediators of cognitive behavioral therapy for anxiety-disordered children and adolescents: cognition, perceived control, and coping.
abstract: The purpose is to investigate whether a change in putative mediators (negative and positive thoughts, coping strategies, and perceived control over anxious situations) precedes a change in anxiety symptoms in anxiety-disordered children and adolescents receiving cognitive behavioral therapy (CBT). Participants were 145 Dutch children (8-18 years old, M = 12.5 years, 57% girls) with a primary anxiety disorder. Assessments were completed pretreatment, in-treatment, posttreatment, and at 3-month follow-up. Sequential temporal dependencies between putative mediators and parent- and child-reported anxiety symptoms were investigated in AMOS using longitudinal Latent Difference Score Modeling. During treatment an increase of positive thoughts preceded a decrease in child-reported anxiety symptoms. An increase in three coping strategies (direct problem solving, positive cognitive restructuring, and seeking distraction) preceded a decrease in parent-reported anxiety symptoms. A reciprocal effect was found for perceived control: A decrease in parent-reported anxiety symptoms both preceded and followed an increase in perceived control. Using a longitudinal design, a temporal relationship between several putative mediators and CBT-outcome for anxious children was explored. The results suggest that a change in positive thoughts, but not negative thoughts, and several coping strategies precedes a change in symptom reduction and, therefore, at least partly support theoretical models of anxiety upon which the anxiety intervention is based.
authors.affiliation: a Department of Child and Adolescent Psychiatry/De Bascule , Academic Medical Center.
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Hogendoorn
authors.forename: Pier J M
authors.initials: PJ
authors.lastname: Prins
authors.forename: Frits
authors.initials: F
authors.lastname: Boer
authors.forename: Leentje
authors.initials: L
authors.lastname: Vervoort
authors.forename: Lidewij H
authors.initials: LH
authors.lastname: Wolters
authors.forename: Harma
authors.initials: H
authors.lastname: Moorlag
authors.forename: Maaike H
authors.initials: MH
authors.lastname: Nauta
authors.forename: Harry
authors.initials: H
authors.lastname: Garst
authors.forename: Catharina A
authors.initials: CA
authors.lastname: Hartman
authors.forename: Else
authors.initials: E
authors.lastname: de Haan
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D002648:Child; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010290:Parents / Q000523:psychology; D010465:Perception; D011340:Problem Solving; D012720:Severity of Illness Index; D013850:Thinking; D016896:Treatment Outcome